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Outpatient Facility Coding Alert

Reader Question:

Remember to Code Separately for PICC, Fluoroscopy

Question: How do I code for a peripherally inserted central venous catheter (PICC) line placement with fluoroscopic guidance for a 75-year-old patient with a bladder infection? The patient is undergoing antibiotic therapy for the next six weeks. May I still bill if the line placement is unsuccessful?

Answer: To code for the insertion of a PICC, you should report code 36569 (Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older) since the patient is above 5 years of age. You may also code separately for the fluoroscopic guidance using code +77001 (Fluoroscopic guidance for central venous access device placement, replacement [catheter only or complete], or removal [includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position] [List separately in addition to code for primary procedure]).

However, note that in the facility setting, if the provider terminates the procedure prior to anesthesia administration due to extenuating circumstances that threaten the well-being of the patient, then you should report modifier 73 (Discontinued Out-patient Hospital/Ambulatory Surgery Center (ASC) Procedure prior to the administration of anesthesia) with code 36569. For terminated procedures in which anesthesia had already been administered, you will report 36569 with modifier 74 (After Anesthesia Administration - Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital). In the example provided, you will use modifier 74 for an unsuccessful line placement.

Whether or not the procedure is discontinued before or after anesthesia administration, you should not bill out for +77001 for an unsuccessful line placement.

Refer to the following for more information: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM3507.pdf.


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